1. Copyright (2006) Medic-to-Medic July 2006 Mobilising best practice across healthcare ________________________________________

2. Copyright (2006) Medic-to-Medic July 2006 Agenda Background A Problem A Solution Demonstration Benefits Summary Discussion

3. Copyright (2006) Medic-to-Medic July 2006 Map of Medicine History 19992001 20032005 200720062004 First pathways created and user display Graphical Tree display created South East North East Wales Hand Held Solution

4. Copyright (2006) Medic-to-Medic July 2006 Background: Recent Progress UK Adoption 3/5 th of England Wales

5. Copyright (2006) Medic-to-Medic July 2006 Information overload Clinical governance: Overload of guidelines Students, locum and agency staff Increasing patient safety issues and rising patient expectations: Less patient time, more referrals Recent data: Medical errors Rising cost of claims Value of evidence A Few Problems in Healthcare

6. Copyright (2006) Medic-to-Medic July 2006 * Jeremy C Wyatt, Frank Sullivan. Keeping up: learning in the workplace. BMJ 2005;331:1129-1132 (12 November) ** Prof. Paul Glasziou, 2005 *** Don Goldenberg and Nicole Smith. Fibromyalgia, Rheumatologists, and the Medical Literature: A Shaky Alliance. J Rheumatol 2003;30:151-3 The amount of biomedical knowledge doubles every 20 years* Per day**: 5000 biomedical articles 1260 new articles in Medline Example: the total number of medical articles dealing with fibromyalgia has increased 5-fold during the past decade*** More than 35,000 journals in publication Growing Information Base

7. Copyright (2006) Medic-to-Medic July 2006 In the UK, in guidelines alone, there is an overwhelming number and volume: Example GP Practice - 855 different guidelines:* a pile 68 cm high weighing 28 kg * Guidelines in general practice: the new Tower of Babel? BMJ 1998;317:862-863 ** Guidelines on anticoagulant treatment in atrial fibrillation in Great Britain: variation in content and implications for treatment. BMJ 1998;316:509-513 Significant variation:** Content Development Dissemination Implementation Evaluation How do we stay current and consistent? Clinical Governance - Overload

8. Copyright (2006) Medic-to-Medic July 2006 Need to address student, trainee, and locum staff… Especially relevant for the UK where the ratio of junior to senior doctors is 1.4:1 (the EU average is 1:4)* About 25% of NHS consultations are provided by locum staff Variable clinical and/or local knowledge * Tony Sheldon. Pressure mounts over European Working Time Directive. BMJ 2004;328:911 (17 April) Clinical Governance

9. Copyright (2006) Medic-to-Medic July 2006 Docs have less time with patients and referrals are increasing: An average face to face GP appointment is just 8.2 minutes in the UK* Excessive increased number of inappropriate referrals** * Brian H McKinstry, Telephone consultations may not save time, BMJ 2002;325:1242 ** G J Elwyn, N C H Stott, Avoidable referrals? Analysis of 170 consecutive referrals to secondary care. BMJ 1994;309:576-578 (3 September) ** D T Lipman. Appropriateness of referrals to hospital. Appropriateness of referrals to hospital. BMJ 1994;309:1233 (5 November) Patient Safety

10. Copyright (2006) Medic-to-Medic July 2006 Cost of Medical Errors Patient Safety: Recent data UK*: About 10% of patients in NHS unintentionally harmed Patient safety incidents cost the NHS an estimated £3 billion a year 50% of these patient safety incidents could have been avoided * National Audit Office (2005) A Safer Place for Patients: Learning to improve patient safety

11. Copyright (2006) Medic-to-Medic July 2006 Patient Safety: Recent data Power of Evidence 80% of physicians changed their care as a result of evidence* as follows: Avoided hospitalisation in 12% Reduced overall length of stay in hospital in 19% Changed diagnostic tests in 51% and drug choices in 45% Avoided additional tests or procedures in 49% Adhering to evidence-based guidelines for treating hypertension alone could save at least $1.2 billion annually in US** * Marshall J G. The impact of the hospital library on clinical decision making: the Rochester study. Bull Med Libr Assoc. 1992 April; 80(2): 169–178 ** Fischer MA, Avorn J. Economic implications of evidence-based prescribing for hypertension: can better care cost less? JAMA 2004;291:1850-6.

12. Copyright (2006) Medic-to-Medic July 2006 Clinical, evidence-based knowledge at the point of care to assist clinicians Single point of access to the latest research, linked to to NLH and other national knowledge sources – a total healthcare knowledge solution Disseminated in a format relevant and appropriate to the care context A Solution: The Map of Medicine

13. Copyright (2006) Medic-to-Medic July 2006 A Solution: The Map of Medicine Localisable and customisable, enhancing clinical governance through a managed process for consistency Consistently and easily available to all staff, including local information Supports making the right referrals when needed

14. Copyright (2006) Medic-to-Medic July 2006 Over 500,000 s tudy reports in journal articles, research and trials per annum Systematic reviews (Cochrane reviews) & National Guidelines Collate evidence to define best practice Map of Medicine at point of care International Research National Template Continual Review and monitoring Evidence-based knowledge at the point of care A Solution: The Map of Medicine

15. Copyright (2006) Medic-to-Medic July 2006 Graphical Tree – Localisation Localised Original

16. Copyright (2006) Medic-to-Medic July 2006 A Brief Demonstration

17. Copyright (2006) Medic-to-Medic July 2006 The Map of Medicine – Benefits Summary For clinicians Up to date and evidence-based Time saving –Your visualised thought- and workflow –Fast and simple to use – “Less is More” A personalized source of structured and visual clinical and admin information For managers / planners / insurers Driving standardisation of practice - minimising risk Enhancing patient safety Supporting clinical governance - a single source of best practice guidance Minimises the risks of poor referrals, inappropriate tests and procedures Facilitating strategic planning and efficient use of resources For IT professionals Easy to implement and maintain Web based component of IT transformation Supports implementation of international terminology (e.g. SNOMED-CT) and messaging standards (e.g. HL7v3)

18. Copyright (2006) Medic-to-Medic July 2006 Thank you for your time Discussion enone.honeyman@informa.com

19. Copyright (2006) Medic-to-Medic July 2006 Patient Clinician EVIDENCE CHOICE DECISION

20. Copyright (2006) Medic-to-Medic July 2006 International Evidence Content Integration System Administration Localisation Pathway Manager Security User Maintenance Reporting Content Output Interface to local EPR Interface to NLM XML Create Local Pathways Edit existing pathways Create local documents Embed links to local resources Link to local documents Add user notes Add user feedback User Interface View and print pathways Find and print evidence Find and print local knowledge Software Components Map Navigator System Overview

21. Copyright (2006) Medic-to-Medic July 2006 Patient Clinician Content Expert Draft (NHS) Evidence Base Research Literature Reviews Internal Clinical Review External Peer Review SNOMED CT Coding International Content